**LIMITED ENTRY** ENTRIES CLOSE 11:59pm MST Wednesday, November 7 th, 2018

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1 OFFICIAL PREMIUM LIST Cal K-9 Obedience Club of Calgary CAL K-9 OBEDIENCE CLUB OF CALGARY Is hosting TWO LICENSED ALL BREED OBEDIENCE TRIALS (unexamined, unbenched and indoors) SUNDAY, NOVEMBER 25, 2018 Fez Dome #5525, Street NW Calgary, AB T3L 1S4 JUDGES Trial #1 All Regular Classes EVA O KEEFE Street Edmonton, AB T6L 5V1 Trial #2 All Regular Classes MARIE-J CLOUTIER 3990 Radisson Montreal, QC H1M 1X6 **LIMITED ENTRY** ENTRIES CLOSE 11:59pm MST Wednesday, November 7 th, 2018 MAIL ENTRIES TO: Show Secretary: TKO Show Services, Terry Olson A Street NE Calgary, AB T2E 4W5 Phone tkoshowservices@gmail.com ( is for information and questions only, no entries will be accepted via ) WE ARE TAKING ONLINE ENTRIES!!! This event is not open to mixed or unrecognized breeds. The show precincts defined as: Fez Dome, Calgary AB These events held under the rules of the Canadian Kennel Club FUN MATCH Saturday Evening, November 24, 2018 Fez Dome BY PRE-REGISTRATION ONLY Match start time: TBD. Entry fee is $10.00 per dog. Limit two dogs per person. Limited entry. For information contact Jackie Hastie at or cheetah8@telus.net For pre-registration please send dog s name, breed, class, jump height, owner s name, address and phone number along with a cheque to: Jackie Hastie 256 Deer Run Close SE, Calgary, AB T2J 5P6 Please make all cheques payable to: Cal K-9 Obedience Club of Calgary

2 CAL K-9 OBEDIENCE CLUB OF CALGARY EXECUTIVE: President: Kim Zippel Vice President: Jill Brown Secretary: Michelle Whistlecraft Treasurer: Alice Menczel Past President: Leanne Tucker TRIAL COMMITTEE: Trial Chairperson: Angela Borthwick ShowSuperintendent: Angela Borthwick Show Secretary: TKO Show Services Terry Olson Chief Ring Steward: Jill Brown Ribbons: Mary Ann Dalton Prizes: Leanne Tucker Raffle: Nikki Wiebe Treat Table: Robyn Gallacher Equipment: Kristi Wright-Fraser Lunches: Kim Zippel Photographer: Garry Baldwin TRIAL COMPLAINTS COMMITTEE: Gwen Haynes, Jill Brown, Leanne Tucker, MaryAnn Dalton and Kristi Fraser OFFICIAL VETERINARIAN Montgomery Village Veterinary Clinic & Dekens Housecall Services 117, 4611 Bowness Road NW, Calgary, AB T3B 0B CANADIAN KENNEL CLUB 200 Ronson Drive, Suite 400, Etobicoke, Ontario M9W 5Z CANADIAN KENNEL CLUB DIRECTOR FOR ALBERTA Sharon Derrick, 60 Riverview Cl. SE, Calgary, AB T2C 4C CANADIAN KENNEL CLUB ALBERTA OBEDIENCE REPRESENTATIVE Lionel Whittaker 4529 Mead Court NW, Edmonton AB T6R 0T ENTRY FEES PLEASE COMPLETE ONE ENTRY FORM PER DOG PER CLASS PER TRIAL (i.e. one entry form for Open 18B or HB and another entry form for Utility B) Entry fee for each dog for each trial $27.00 Entry fee for same dog entered in Open 18B or HB and Utility B for each trial $50.00 Day of Entry, per class, per trial CASH ONLY (Space permitting) $50.00 Exhibition Only $8.00 Listing Fee $10.50 Please make all cheques payable to: Cal K-9 Obedience Club of Calgary No post dated cheques will be accepted. NOTE: "Day of Entry" entries will only be accepted up to one hour prior to judging of the trial being entered. Overpayment of entry fees will be considered a donation to the club. Tendering of an NSF cheque shall be considered non-payment of entry fees and is an offence punishable by disciplinary action and cancellation of awards by the Canadian Kennel Club. A fee of $25.00 will be charged for any returned cheque. Attention Foreign Exhibitors: Please note that fees are due and payable in Canadian dollars. Due to inconsistently fluctuating currency rates, discounted cheques will not be accepted. Personal cheques will be accepted however, they are to be payable in Canadian funds. If you send a cheque in US funds, it must be made out for the full amount of the entry and no exchange will be refunded to the exhibitor. Please do not mark cheques Payable in Canadian Funds or At Par. The banks will not clear them. To simplify the process, we urge that you purchase bank drafts or money orders payable in Canadian funds. Your understanding and cooperation is appreciated. All entries must contain complete information as required by the CKC rules. All entries must be accompanied by the entry fee, in full, and all listing fees where applicable. A listing fee as established by the CKC must accompany the entry of a dog for which a CKC individual registration number is not shown on the entry form or ERN notice. ATTENTION CANADIAN EXHIBITORS WHO ARE NOT CKC MEMBERS Effective January 1st, 2011, NON-MEMBER PARTICIPATION FEE ***Payment of this new fee is not required to enter this show*** This fee only applies to dogs wholly owned by non-member residents of Canada and is not applicable to CKC members or dogs co-owned with a CKC member, nor does it affect US exhibitors who must apply for an ERN number (see below). This fee is applicable starting at the first event in which the dog earns awards, points, titles, legs and is not pro-rated. Non-members will receive a letter from CKC Head Office informing them that they have 30 days to join the Club or pay the Non-Member Participation Fee. Dogs co-owned by two or more individuals...the first person listed in the CKC dog records will be considered the caregiver of the dog and all communication will be sent to this person. For further information please contact the CKC or see their website *Please note that the CKC Membership application and the Non-Member Participation Fee forms are available on the website under CKC Services and then Forms On-Line. NOTICE TO ALL FOREIGN EXHIBITORS ERN NUMBERS All foreign born and foreign owned dogs who enter Canada for the sole purpose of entering CKC events do not require a CKC registration number but will require an ERN (Event Registration Number). To obtain an ERN, mail or fax a photocopy of the dog s foreign registration certificate with cheque or VISA/Mastercard number (expiry date, cardholder s name and signature). Provide your complete address for return

3 of ERN to you. The cost is $ Dog may initially be entered as listed but the ERN must be applied for within 30 days of winning CKC points, awards, or scores to avoid cancellation. Forward request to: The Canadian Kennel Club, Shows and Trials Division, #400, 200 Ronson Drive, Etobicoke, Ontario M9W 5Z9. FAX (416) or obtain form at GENERAL INFORMATION ENTRY FEES SHALL NOT BE REFUNDED AFTER THE CLOSING DATE in the event that a dog is absent, disqualified, excused by Veterinarian or Judge, or barred from competition by action of Trial Committee, or because it has been entered incorrectly. If because of riot, civil disturbance, or other acts beyond the control of the Club, it is impossible to open or complete the show, no refund of entry will be made. Overpayments will not be refunded. ENTRY FEES WILL BE REFUNDED WHEN A BITCH ENTERED IN OBEDIENCE COMES INTO SEASON after entry of the bitch has been submitted if a Veterinarian's certificate, (certifying that the bitch was in season within the ten-day period preceding the trial), is delivered to the Trial Secretary on or before the date of the trial. Entries must be typewritten or clearly printed. Owners are responsible for errors on entry forms. Cal K-9 Obedience Club of Calgary does not assume any responsibility for incorrect information or errors due to illegibility of information on any entry form. Make cheques payable to Cal K- 9 Obedience Club of Calgary. No post-dated cheques will be accepted. ENTRIES WILL BE ACKNOWLEDGED AFTER CLOSING DATE. Receipts and judging schedule will be ed. Please ensure address is printed on your entry form. Armband numbers and catalogues will be available one hour before the trials begin. (Chapter 3, Section CKC Obedience Trial Rules & Regulations). "A judge officiating at a trial held under these Rules shall not be subjected to indignities of any kind during the progress of the trial. It shall be the duty and obligation of the club holding the trial to see that this rule is effectively carried out." ALL DOGS MUST BE KEPT UNDER CONTROL AT ALL TIMES. If not in competition, the dog must wear a collar and be on a leash a maximum length of six (6) feet or appropriately confined in the benching area. Dogs must be exercised in designated areas ONLY. All empty rings are to be kept free of dogs. An exhibitor has the right to withdraw an entry. This Notice of Withdrawal must be in writing and received by the Show Secretary on or before the official closing date and time as published in the Premium List. All Miscellaneous Class Dogs who do not have a Certification Number can only compete at the Novice level in Obedience Trials and must pay a listing fee of $ Those dogs with a certification number may proceed through all levels. Titles will only be awarded to those dogs that have been certified. In Transit permits will be available from the trial secretary if needed. Dogs not entered in the trials in the regular classes or exhibition only will not be permitted in the building without an In Transit Permit. Performance Event Number (PEN) allows an unregisterable dog of a CKC recognized breed to participate in competitive events that are appropriate for the breed. For more information regarding applying for a PEN visit Cal K-9 Obedience Club of Calgary, its members and volunteers will use due care and diligence for the welfare of dogs and exhibitors, BUT will not be responsible for, nor assume any liability in the event of an accident or other misfortune to either dogs, exhibitors or patrons. The Trial Superintendent has the authority to expel any dogs deemed to be a danger to other dogs or people. There will be no refund for dogs that are expelled. OFFICIAL CLASSES Pre Novice This is for any dog of any recognized or listed breed which has not earned the title of P.C.D (Pre-Companion Dog). Dogs in this class may be handled by the owner or any other person. A person may enter more than one dog in this class and must have an additional handler for each dog when they are judged together in the Group Exercise. A dog that has earned the title of C.D. is not eligible for this class. This class is an elective class and earning the title is not a requirement to advance to the Novice Classes. Novice A - This is for any dog of any recognized or listed breed which has not earned the title of C.D. (Companion Dog). Only one dog may be entered in this class by any one exhibitor. The dog must be handled by the owner or a member of his immediate family. No person who has previously trained or exhibited a dog through its C.D.X. (Companion Dog Excellent) title shall be allowed to handle a dog in this class. Novice B - This is for any dog of any recognized or listed breed which has not earned the title of C.D. (Companion Dog). Dogs in this class may be handled by any person. More than one dog may be entered by any handler, but each dog must have a separate handler for the group exercises. No dog may be entered in both the Novice A and Novice B class at any one trial. Novice C This is for any dog of any recognized or listed breed which has earned the title of C.D., C.D.X., U.D., or any Obedience Trial Championship Title prior to the closing date of the trial in which it is to be entered. Dogs in this class may be handled by any person. More than one dog may be entered by any handler, but each dog must have a separate handler for the group exercises. Dogs may compete in the Novice C class indefinitely. Scores earned by dog in the Novice C Class are not eligible for High in Trial and do not qualify a dog for any title. Novice Intermediate This is for any dog of any recognized or listed breed which has earned the title of C.D., C.D.X., U.D., or any Obedience Trial Championship. Scores earned by dogs competing in this class are not eligible for High in Trial. A person may enter more than one dog in this class. This class is an elective class and earning the title is not a requirement to enter the Open classes. Open HA / 18A - This is for any dog of any recognized or listed breed which has earned the title of C.D. but has not earned the title of C.D.X. (Companion Dog Excellent). Only one dog may be entered in this class by any one exhibitor. The dog must be handled by the owner or a member of his immediate family. Any person who has previously trained or exhibited a dog that has earned a U.D. title may not handle a dog in this class. Open HB / 18B - This is for any dog of any recognized or listed breed which has earned the title of C.D. in Canada. Dogs in this class may be handled by any person. More than one dog may be entered by any handler, but each dog must have a separate handler for the group exercises. No dog may be entered in both Open HA/18A and Open HB/18B at any one trial. A dog that has earned the title of C.D.X. must compete in Open B. Dogs eligible for entry in the Utility Class are also eligible for entry in this class. Utility A - This is for any dog of any recognized or listed breed that has earned the title of C.D.X., but has not earned the title of U.D. The dog must be handled by the owner or a member of his immediate family. Any person who has trained or exhibited a dog that has earned a M.O.T.C.H title may not handle dogs in this class. Handlers may enter more than one dog in this class. Utility B This is for any dog of any recognized or listed breed that has earned the title of C.D.X. or U.D. Dogs in this class may be handled by the owner or any other person. Owners may enter more than one dog in this class. No dog may be entered in both Utility A and Utility B at the same trial.

4 PRIZE LIST TRIAL #1 High in Trial Sponsored by Colleen Laidley Wegewitz, in memory of Finlay $50 & Rosette High Combined (Open HB/18B & Utility B) Sponsored by Alice Menczel $50 & Rosette High Scoring Novice A Sponsored by Kathy Clark $25 High Scoring Novice B Sponsored by Mandy McKay $25 High Scoring Open 18A Sponsored by Robyn Gallacher $25 High Scoring Open HA Sponsored by Gwen Haynes $25 High Scoring Open 18B Sponsored by Gwen Haynes $25 High Scoring Open HB Sponsored by Zaniri Golden Retrievers $25 High Scoring Utility A Sponsored by Michelle Whistlecraft $25 High Scoring Utility B Sponsored by Zaniri Golden Retrievers $25 2 nd in class in Novice A Sponsored by Liz Saunders Prize 2 nd in class in Novice B Sponsored by Ellen Kovar Prize 2 nd in class in Open 18A Sponsored by Ellen Kovar Prize 2 nd in class in Open HA Sponsored by Liz Saunders Prize 2 nd in class in Open 18B Sponsored by Elaine MacDonald, in honour of Jolly our grand dam Prize 2 nd in class in Open HB Sponsored by Elaine MacDonald, in honour of Jolly our grand dam Prize 2 nd in class in Utility A Sponsored by Elaine MacDonald, in honour of Jolly our grand dam Prize 2 nd in class in Utility B Sponsored by Elaine MacDonald, in honour of Jolly our grand dam Prize 3 rd in class in Novice A Sponsored by Lisa Williams Prize 3 rd in class in Novice B Sponsored by Lisa Williams Prize 3 nd in class in Open 18A Sponsored by Lisa Williams Prize 3 nd in class in Open HA Sponsored by Lisa Williams Prize 3 nd in class in Open 18B Sponsored by Lisa Williams Prize 3 nd in class in Open HB Sponsored by Lisa Williams Prize 3 nd in class in Utility A Sponsored by Lisa Williams Prize 3 nd in class in Utility B Sponsored by Lisa Williams Prize 4 th in class in Novice A Sponsored by Leanne Tucker Prize 4 th in class in Novice B Sponsored by Leanne Tucker Prize 4 th in class in Open 18A Sponsored by Leanne Tucker Prize 4 th in class in Open HA Sponsored by Leanne Tucker Prize 4 th in class in Open 18B Sponsored by Leanne Tucker Prize 4 th in class in Open HB Sponsored by Leanne Tucker Prize 4 th in class in Utility A Sponsored by Leanne Tucker Prize 4 th in class in Utility B Sponsored by Leanne Tucker Prize Qualifying Pre-Novice Exhibitors Sponsored by Tammy Taylor, in honour of my first Pre Novice dog Maci Prize Qualifying Novice-Intermediate Sponsored by Cal K-9 Obedience Club Prize 1 st in class 4 th in class in Novice C Sponsored by Cal K-9 Obedience Club Prize

5 TRIAL #2 High in Trial Sponsored by Jackie Hastie / Pauline Baldwin $50 & Rosette High Combined (Open HB/18B & Utility B) Sponsored by Carolyn Tucker, in memory of Cedar $50 & Rosette High Scoring Novice A Sponsored by Michelle Whistlecraft $25 High Scoring Novice B Sponsored by Fotina Karavas $25 High Scoring Open 18A Sponsored by Susan Endersby, in memory of Misty $25 High Scoring Open HA Sponsored by Kelly Ladouceur $25 High Scoring Open 18B Sponsored by Susan Light, in memory of Wager Arkeno s Place Your Bets $25 High Scoring Open HB Sponsored by Susan Light, in memory of Wager Arkeno s Place Your Bets $25 High Scoring Utility A Sponsored by Bow River Retrievers $25 High Scoring Utility B Sponsored by Bow River Retrievers $25 2 nd in class in Novice A Sponsored by Jackie Wepruk Prize 2 nd in class in Novice B Sponsored by Jackie Wepruk Prize 2 nd in class in Open 18A Sponsored by Jackie Wepruk Prize 2 nd in class in Open HA Sponsored by Jackie Wepruk Prize 2 nd in class in Open 18B Sponsored by Rachel Jesse Prize 2 nd in class in Open HB Sponsored by Rachel Jesse Prize 2 nd in class in Utility A Sponsored by Rachel Jesse Prize 2 nd in class in Utility B Sponsored by Rachel Jesse Prize 3 rd in class in Novice A Sponsored by Lisa Williams Prize 3 rd in class in Novice B Sponsored by Lisa Williams Prize 3 nd in class in Open 18A Sponsored by Lisa Williams Prize 3 nd in class in Open HA Sponsored by Lisa Williams Prize 3 nd in class in Open 18B Sponsored by Lisa Williams Prize 3 nd in class in Open HB Sponsored by Lisa Williams Prize 3 nd in class in Utility A Sponsored by Lisa Williams Prize 3 nd in class in Utility B Sponsored by Lisa Williams Prize 4 th in class in Novice A Sponsored by Leanne Tucker Prize 4 th in class in Novice B Sponsored by Leanne Tucker Prize 4 th in class in Open 18A Sponsored by Leanne Tucker Prize 4 th in class in Open HA Sponsored by Leanne Tucker Prize 4 th in class in Open 18B Sponsored by Leanne Tucker Prize 4 th in class in Open HB Sponsored by Leanne Tucker Prize 4 th in class in Utility A Sponsored by Leanne Tucker Prize 4 th in class in Utility B Sponsored by Leanne Tucker Prize Qualifying Pre-Novice Exhibitors Sponsored by Tammy Taylor, in honour of my first Pre Novice dog Maci Prize Qualifying Novice-Intermediate Sponsored by Cal K-9 Obedience Club Prize 1 st in class 4 th in class in Novice C Sponsored by Cal K-9 Obedience Club Prize AWARDS OVER BOTH TRIALS High Aggregate - To be awarded to dog and handler who achieve the highest combined qualifying score from both Trials. Dog must qualify in the same class and must be handled by the same handler in both Trials $50 & Rosette sponsored by Cathy French (In the event of a tie for High Aggregate, the run-off will be judged by both judges) High Scoring Sporting Dog - $40 sponsored by Nicola Roe, in memory of Mini but Mighty Finn who always gave his whole heart High Scoring Hound Dog- Prize sponsored by Sarah-Jane Brenner-Petti High Scoring Working Dog Prize sponsored by Kristi Fraser High Scoring Terrier Dog Prize sponsored by Cal K-9 Obedience Club High Scoring Toy Dog Prize sponsored by Cal K-9 Obedience Club High Scoring Non-Sporting Dog Prize sponsored by Cal K-9 Obedience Club High Scoring Herding Dog $25 sponsored by Tracie Ball, in memory of Cairo High Scoring Conformation Champion of Record - Prize sponsored by Leanne Tucker High Scoring Utility first leg (highest score overall either trial) - Prize sponsored by Mary Ann and Gloria Dalton High Scoring 2018 Obedience Partner student that has never earned a MOTCH on a dog - $30 sponsored by Jackie Hastie & Pauline Baldwin Oldest Qualifying Dog - Prize sponsored by Leanne Tucker, in memory of Cedar - Can CH GMOTCH U-CDX Hollykins Gold'N Cedar WC AGX AGXJ SHDX RE; Am UD WC NA NAJ NF RN CCA A qualifying score must be earned for all prizes to be awarded. DRAWS Armband Draw: Prize sponsored by Cal K-9 Obedience Club Woulda, Coulda, Shoulda Draw: Prize sponsored by Cal K-9 Obedience Club ALL PRIZES MUST BE CLAIMED AT THE SHOW.

6 LUNCH Our fabulous catering team of Kim Zippel and Baba Ukrainetz are once again preparing lunches (vegetarian and non-vegetarian options) for our judges and volunteers. Lunch is available to exhibitors which have pre-ordered on their entry form and prepaid by including $10.00 in their entry fee payment. Please indicate on the entry form if you prefer a vegetarian lunch. *** LOCATION *** Fez Dome 5525, Street NW, Calgary, AB T3L 1S4 All dogs must be on leash outside the building and kept away from the horses. There will be 2 rings, a warm up area and plenty of benching space. The surface will be packed down dirt It shall be the duty and obligation of the trial-giving club to see that a judge, club official, ring steward, volunteer, or competitor at an Obedience Trial held under these regulations, is not subject to indignities of any kind. The Obedience Trial Committee Chair shall promptly report to the CKC any infringement of this regulation, and the Discipline Committee shall have the authority to take such action as it deems fit on receipt of a report indicating that this has occurred.

7 OFFICIAL CANADIAN KENNEL CLUB ENTRY FORM Cal K-9 Obedience Club of Calgary OBEDIENCE TRIALS Sunday November 25, 2018 Cal K-9 Obedience Club of Calgary OFFICIAL CANADIAN KENNEL CLUB ENTRY FORM Cal K-9 Obedience Club of Calgary OBEDIENCE TRIALS Sunday November 25, 2018 Cal K-9 Obedience Club of Calgary I ENCLOSE $ ENTRY FEES $ LISTING FEES $ Entries Close 11:59 pm MST Wednesday November 7 th, 2018 PLEASE TYPE OR PRINT CLEARLY FILL IN ONE ENTRY FORM PER DOG PER CLASS PER TRIAL. BREED MALE FEMALE Trial # 1 Trial # 2 Please check if you are eligible for these prizes: Pre Novice Open HA Conformation Champion Novice A Open 18A 1st Utility Leg Novice B Novice C Novice Intermediate Exhibition Only Open HB Open 18B Utility A Utility B High Scoring 2018 Obedience Partner student no MOTCH Jump Height: / Lunch Pre-Order ($10.00) Vegetarian REG. NAME OF DOG I ENCLOSE $ ENTRY FEES $ LISTING FEES $ Entries Close 11:59 pm MST Wednesday November 7 th, 2018 PLEASE TYPE OR PRINT CLEARLY FILL IN ONE ENTRY FORM PER DOG PER CLASS PER TRIAL. BREED MALE FEMALE Trial # 1 Trial # 2 Please check if you are eligible for these prizes: Pre Novice Open HA Conformation Champion Novice A Open 18A 1st Utility Leg Novice B Novice C Novice Intermediate Exhibition Only Open HB Open 18B Utility A Utility B High Scoring 2018 Obedience Partner student no MOTCH Jump Height: / Lunch Pre-Order ($10.00) Vegetarian REG. NAME OF DOG CHECK ONE AND ENTER NUMBER HERE DATE OF BIRTH ON SHOW DATE IS THIS A PUPPY? CKC REG. NO. CKC MISC. CERT. NO. CKC PEN NUMBER: BREEDER(S) CKC ERN LISTED / / Day Month Year PLACE OF BIRTH CANADA ELSEWHERE YES NO CHECK ONE AND ENTER NUMBER HERE DATE OF BIRTH ON SHOW DATE IS THIS A PUPPY? CKC REG. NO. CKC MISC. CERT. NO. CKC PEN NUMBER: BREEDER(S) CKC ERN LISTED / / Day Month Year PLACE OF BIRTH CANADA ELSEWHERE YES NO SIRE SIRE DAM DAM REG D OWNER(S) CKC MEMBERSHIP NUMBER REG D OWNER(S) CKC MEMBERSHIP NUMBER OWNER S ADDRESS CITY PROV./STATE POSTAL CODE NAME OF OWNER S AGENT (IF ANY) AT THE SHOW OWNER S ADDRESS CITY PROV./STATE POSTAL CODE NAME OF OWNER S AGENT (IF ANY) AT THE SHOW AGENT S ADDRESS CITY PROV./STATE POSTAL CODE Credit Card Number: (for schedule and confirmation) Expiry: VISA Mastercard AMEX I CERTIFY that I am the registered owner(s) of the dog or that I am the authorized agent of the owner(s) whose name(s) I have entered above and accept full responsibility for all statements made in this entry. In consideration of the acceptance of this entry, I (we) agree to be bound by the rules and regulations of the Canadian Kennel Club and by any additional rules and regulations appearing in the premium list. AGENT S ADDRESS CITY PROV./STATE POSTAL CODE Credit Card Number: (for schedule and confirmation) Expiry: VISA Mastercard AMEX I CERTIFY that I am the registered owner(s) of the dog or that I am the authorized agent of the owner(s) whose name(s) I have entered above and accept full responsibility for all statements made in this entry. In consideration of the acceptance of this entry, I (we) agree to be bound by the rules and regulations of the Canadian Kennel Club and by any additional rules and regulations appearing in the premium list. SIGNATURE OF OWNER OR AGENT TELEPHONE NUMBER SIGNATURE OF OWNER OR AGENT TELEPHONE NUMBER

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